Role of the doctorate in public health program, UWI, in strengthening public health capacity in the Caribbean

ABSTRACT

This paper describes the Doctor of Public Health (DrPH) program at The University of the West Indies and its role in building public health capacity in the English-speaking Caribbean. DrPH reports, student assessments and external reviews were used to describe the development of the DrPH program. The program was established in 2009 as a part-time competency-based program over 4–7 years delivered by face-to-face and distant learning modules, electives, field placements, and research leading to a thesis. DrPH scholars have made significant contributions to public health in the Caribbean through their assignments, field placements and research, which are designed to address the needs of Caribbean countries while building the students’ core competencies in public health. As of May 2025, 83 scholars in 12 cohorts have enrolled with 32 graduates, nearly all of whom have remained in the Caribbean in senior technical positions. A Master of Applied Public Health was approved in 2024 as an exit strategy for students who complete Part 1 courses of the DrPH, the end of year-2 examinations (45 credits), and a 6-month field placement but are unable to complete the research thesis. The high retention of graduates in the Caribbean, their placement in senior positions, and actual policy and system outputs have strengthened the capacity of the public health sector. Caribbean health ministers have recommended that the DrPH, or its equivalent, become the required standard for specialist public health consultant practice in the Caribbean. This requirement needs to be implemented to build effective public health capacity in the Caribbean.

Public health practitioners have important leadership roles in preventing disease, promoting health and ensuring health services meet population needs through organized efforts of society (1). In addition to knowledge of diseases and their causes, public health practitioners must understand the environment and social and economic conditions of people, and their culture and behavior (1–3). Public health practice must be evidence-based, ensure essential health functions (1,4), and have a resilient primary health care system (5). Traditionally, the qualification of public health practitioners is a Masters of Public Health (MPH). Many such programs are available in the English-speaking Caribbean (6). However, given the scope of public health and the complexity of challenges, an MPH is no longer adequate for modern public health specialist practice. We see the MPH as the entry requirement for training public health leaders.

Most countries do not have a well developed national policy, plan or mechanism for ensuring adequate human resources for health (7). As a result, chronic shortages and poor distribution of human resources occur. What human resources there are tend to be concentrated in urban centers with a scarcity in rural areas (7–9). While adequate numbers of physicians and nurses are trained in the Caribbean, migration rates are high, especially to North America (7). The main reasons for migration are the desire for higher wages and better working conditions (10). Although efforts have been made to reduce migration through international agreements, aggressive recruitment of nurses and other health professionals continues (11) and the attrition rate of nurses in the Caribbean is 8% annually (10).

POSTGRADUATE TRAINING IN PUBLIC HEALTH IN THE CARIBBEAN

Postgraduate training in public health was introduced at The University of the West Indies (UWI), Mona in 1973: a 1-year full-time Diploma of Public Health for physicians and a 1-year full-time Diploma of Community Health for non-physicians. In 1985, the 1-year MPH replaced these two programs. Subsequently, MPH tracks were introduced in health education and health promotion (2002), health management (2013), and gerontology (2014). Many MPH programs are now part-time with classes through distance learning and most students working full time.

The UWI established postgraduate training programs leading to a Doctor of Medicine (12,13) in several medical specialties in the 1970s and 1980s (14–16). A 1995 survey of senior health officials in the Caribbean identified the urgent need for advanced training in public health and applied epidemiology (17). Stakeholder consultations led to a 1999 report (unpublished) recommending the development of field epidemiology training and a Doctor of Medicine in public health. In April 2003, Caribbean chief medical officers established a task force that prepared an action plan promoting training in public health leadership in the Caribbean (17). This plan was submitted to Caribbean health ministers in September 2003 (18). The need for advanced training in public health was justified based on the role of public health practitioners given the wide range of diseases and health problems, and the need for in-depth understanding of how best to investigate them and take evidence-based approaches to develop, implement, and evaluate policy, plans, programs, and services for different populations and communities across the life course. A simple analogy is that brain surgery is done by a neurosurgeon with several years of specialist training and supervised experience. Similarly, population health problems need highly trained public health specialists.

No tangible progress was made until Dr Nigel Harris, then the Vice-Chancellor of UWI, approached Dr Peter Figueroa to join UWI to establish a doctoral program for the region. In 2007 Dr Nigel Harris established a high-level cross campus committee called the Task Force for Postgraduate Training in Public Health Leadership and Health Promotion (19). The Task Force developed a proposal for postgraduate public health training that was presented to and approved by various UWI committees. Following approval, Dr Figueroa worked closely with Dr Michelle Harris and other colleagues to develop the curriculum for a Doctorate in Public Health (DrPH) (19). They reviewed doctoral training programs in the United States of America and the United Kingdom of Great Britain and Northern Ireland (including site visits), held consultations with colleagues across UWI campuses, and explored the range of competencies needed to address health needs and practise public health in the Caribbean and other developing countries. In September 2009, seven physicians enrolled in the first cohort of the DrPH program at UWI. In September 2010, the second cohort of students included three public health doctors, one psychiatrist, one health planner, one non-medical epidemiologist, and a practitioner with a Master of Science degree in development studies.

This paper describes the DrPH program at UWI, its achievements, challenges, and role in building public health capacity in the Caribbean.

DrPH PROGRAM AT UWI

UWI internal reports and minutes of meetings were used to describe events leading to establishment of the DrPH. Reports on the DrPH program sent to the following people were used to identify achievements and challenges: Head of Department, DrPH Specialty Board, UWI campus principals, and Caribbean health ministers. In addition, student assessments of DrPH courses, reports of four external examiners, an independent evaluation of the DrPH program in 2012, and external reviews of MPH and DrPH programs in 2017 were also used. Ethical approval was not required for this review.

Aim

The aim of the DrPH is to provide public health specialist training and facilitate the development of advanced competencies of graduates that will positively affect the health status in the Caribbean (20). The vision of the DrPH is to train and empower outstanding public health leaders to transform health services and the health of the Caribbean people. Consequently, graduates must have appropriate knowledge, attitudes, values, skills, and behaviors (21,22).

On completion of the program graduates should be able to:

• demonstrate leadership in organization of public health services;

• apply the skills of policy analysis and program development to improve individual and community health;

• analyze issues and problems in public health using critical evaluation of information from a variety of sources;

• demonstrate in-depth understanding of the core areas of public health theory and practice;

• apply the analytic tools of epidemiology and biostatistics to address specific public health issues;

• apply management and financial management skills in the practice of public health;

• demonstrate effective communication and advocacy skills.

The DrPH is a competency-based professional program preparing graduates for leadership roles in public health services while the PhD in public health is a research degree geared towards a career in academia. The admission criteria for the DrPH is an MPH or equivalent master’s degree with at least an upper second class honors or equivalent. Persons with master’s degrees other than the MPH may need to complete introductory courses in epidemiology or biostatistics before admission to the DrPH. On completion of the DrPH, graduates should have competencies in the following: leadership; analytical thinking; policy analysis and program development; public health practice; working in multidisciplinary teams; communication and advocacy for health; strategic planning and management; and research.

Structure

The DrPH is a part-time program delivered through face-to-face and distant learning modules, electives, field placements, and research. Students must complete 12 core modules (36 academic credits) and elective courses (six credits) for a total of 42 credits over 4 to 7 years (Figure 1). The courses on health across the life course and social and cultural determinants of health were designed to address important gaps in the theoretical understanding of public health practitioners who had already done the MPH. Other gaps addressed by the DrPH were health policy, health systems, leadership and management, quantitative and qualitative research, and public health ethics.

FIGURE 1. Structure of the DrPH program, The University of the West Indies.

DrPH, Doctor of Public Health; PUBH, public health.

^a The program must be completed within 7 years.

Source: The University of the West Indies DrPH handbook (21).

There were three 2–3 week face-to-face teaching blocks in year one and two 3-week blocks in year two. Students attend these sessions in person and participate in regular webinars (90 minutes each) between the face-to-face teaching blocks. During the coronavirus disease 2019 (COVID-19) pandemic, teaching blocks were online instead of face-to-face. Since 2023, the first teaching block of each year is in person while other blocks are online.

Students undertake supervised field placements, which normally extend over a 2-year period and may be done at different locations. Public health practitioners with at least 5 years of experience who demonstrate mastery of specific competencies may apply for a maximum of 12 months exemption from field placement. To be granted exemption, the student must present a portfolio outlining the scope of their experience for assessment of eligibility by DrPH faculty. At the end of each placement, a supervisor’s evaluation is submitted and the student produces a graded report on the field placement. The student also assesses the supervisor. Placements may include government health services at various levels throughout the region, regional health institutions (e.g., Caribbean Public Health Agency and the Caribbean Institute for Health Research), and international agencies such as the United States Centers for Disease Control and Prevention and the Pan American Health Organization (PAHO). Students are also required to design and conduct research leading to a thesis on a topic of public health importance.

Assessment of students

DrPH students must complete the following elements.

• Courses, with students assessed by quizzes, presentations, written assignments, and class participation.

• Comprehensive examinations at the end of year 2, with two written papers, a structured oral public health examination with five stations (each station having a specific examination question and two examiners), and an oral examination the following day where the student may be asked any question by two or three examiners.

• Portfolio, with assessment to determine how much time, if any, is exempted for field placement.

• Field placements, with 1–2 years at various sites requiring a learning contract, examples of work done, written reflections, and supervisors’ reports.

• Ethical approval for a research proposal to complete research methods.

• Written doctoral thesis with oral presentation and examination.

Role in building public health capacity in the Caribbean

As of May 2025, 83 scholars in 12 cohorts have enrolled in the program with 32 graduates, two of whom graduated with high commendation (Table 1). Several scholars are finalizing their research proposals or undertaking research for their thesis (Table 2). Graduates work in high-level positions across the Caribbean, make substantial contributions to public health and strengthen the capacity of health systems. Several graduates have been promoted to senior positions including Assistant Director, PAHO (one graduate), Chief Medical Officer (five graduates), Permanent Secretary (two graduates), and Program Manager for Health Sector Development at CARICOM (one graduate). Graduates are better able to supervise, mentor, and coach the public health practitioners who report to them thus enhancing public health capacity at regional, national, and subnational levels. Four graduates are members of the UWI Faculty in Public Health (one at Cave Hill, Barbados; one at St. Augustine, Trinidad and Tobago; and two at Mona, Jamaica), one is Director of the School of Public Health and Health Technology, University of Technology, Jamaica, and one is a senior lecturer at the University of Guyana. Three graduates live in the United States: one does consultancies in the Caribbean and supports the DrPH program through teaching and two are faculty members at United States universities. One graduate, who was working in Africa when she enrolled, is now a United Nations Children’s Fund country representative in Africa. All other graduates have remained working in the Caribbean. The high level of retention of DrPH graduates within the Caribbean is in contrast to the high level of migration of other health professionals.

TABLE 1. Profile of students enter-ing the DrPH, UWI.

Country	No. of students	No. of graduates	Profile of the students at entry and those with significant promotionsa
Antigua and Barbuda	1	1	Chief Medical Officer (now Assistant Director, PAHO)
Barbados	10	5	5 public health doctors, 1 medical doctor, 1 health planner, 1 private consultant (formerly United Nations Population Fund), 1 environmental health and safety manager, 1 program manager (CARPHA)
Bahamas	2	1	1 public health doctor (now Chief Medical Officer), 1 podiatric doctor
British Virgin Islands	2		1 public health doctor (now Chief Medical Officer), 1 epidemiologist
Cayman Is-lands	1		1 surveillance officer
Dominica	2		1 principal nursing officer, 1 public health nurse
Guyana	10	5	3 public health doctors, 2 health planners, 1 health educator, 1 environmental manager, 1 health informatics, 2 epidemiolo-gists
Jamaica	38	14	25 public health doctors, 1 gynecologist (UWI), 1 health manager, 1 psychiatrist (Medical Director of the Constabulary Service), 1 anthropologist, 3 health specialists (1 Planning Institute of Jamaica, 1 UNICEF South Sudan now Country Representative, Zambia, 1 UNICEF Jamaica), 1 environmental health officer, 1 acting Regional Tech-nical Director, 1 program coordinator, 1 behavior change communication officer, 1 nutritionist, 1 physical ther-apist
Montserrat	1		Non-medical epidemiologist (now Permanent Secretary)
Saint Kitts and Nevis	1		Public health trained medical lecturer UWI (now Chief Medical Officer)
Saint Lu-cia	2	2	1 chief medical officer, 1 chief health planner (former Permanent Secretary and health adviser PAHO)
Trinidad and Tobago	13	4	1 chief medical officer, 1 specialist in sexually transmitted infections (former medical director of an oil company), 1 health manager, 2 public health doctors, 1 primary care doctor, 4 CARPHA staff (1 monitoring and evaluation specialist, 1 epidemiologist, 1 laboratory scientist), 2 epidemiologists (Ministry of Health), 1 journalist
Total	83	32	65 women and 18 men (2 transferred to PhD, 2 failed, and 2 dropped out)

DrPH, Doctor of Public Health; UWI, University of the West Indies; CARPHA, Caribbean Public Health Agency; UNICEF, United Nations Children’s Fund; PAHO, Pan American Health Organiza-tion.

^aPromotion indicated in brackets prefaced by “now”).

Source: Produced by the authors based on student profiles and DrPH records.

TABLE 2. Summary of progress of DrPH students, The University of the West Indies, September 2009–May 2025.

Year of entry	Cohort	No. of students	No. of DrPH graduates	No. for MAPH	In process	Comments
2009	1	7	3	4	0	One student dropped out in year 3; three did not complete theses
2010	2	8	6	1	0	One student dropped out in year 2; one did not complete thesis
2011	3	10	7	2	1	One student did not complete thesis; one voluntarily withdrew with later re-admission
2013	4	5	5	0	0	None
2014	5	7	4	1	2	Research and field placementa
2016	6	7	5	1	1	Research and field placement. One student re-admitted after withdrawal
2017	7	5	1	0	4	Research and field placementa
2019	8	7	1	0	5	Research and field placement.a One student failed to repeat written examination
2020	9	8	0	0	6	Research and field placement.a One student transferred to PhD; one withdrew after failing year 2 examination twice
2021	10	6	0	0	5	Research and field placement.a One student transferred to PhD
2023	11	5	0	0	4	Will begin year 3 in September 2025 or2026. One student took leave of absence
2024	12	8	0	0	8	Will begin year 2 in September 2025 or 2026
Total	12	83	32	9	36	Two students transferred to PhD; two failed; two dropped out

DrPH, Doctor of Public Health; MAPH, Master of Applied Public Health.

^aIndicates that those students listed in the column "in pro-cess" are undertaking their research and field placement.

Source: Generated by the authors based on DrPH records.

DrPH scholars make considerable contributions to public health in the Caribbean through their assignments and field placements, which were designed to address the needs of Caribbean countries while building core competencies. These assignments include preparation of needs assessments, national strategic plans, program plans, reports, policies, project proposals, evaluations, and guidelines on various public health topics. Several assignments of students have been adopted by their ministries of health with amendments as needed.

DrPH research theses have been of a high standard covering a wide range of topics including malaria, tuberculosis, measles/rubella, human immunodeficiency virus (HIV)/sexually transmitted infections, mental health, noncommunicable diseases, and environmental health. The research of at least six students has been highly commended and four scholars won special awards including the Principal’s Award for research and various fellowships. The thesis on measles/rubella was part of the verification process for measles and rubella elimination in the Caribbean. One thesis identified delays in treatment of breast cancer following diagnosis and another demonstrated the significant decline in the incidence of rheumatic fever and the need to revise diagnostic criteria. A few DrPH graduates have published papers based on their thesis; several have presented abstracts at conferences.

Fundraising

The DrPH program is self-financing based on tuition fees. The program has also raised funds to support faculty employment, infrastructure development, and strengthening of information systems. The following funds were raised.

• Global Fund grant of 2 000 000 United States dollars (US$) (through the Pan-Caribbean Partnership against HIV and AIDS) which paid the salary of a lecturer/project officer from 2011 to 2016, and provided financial support to students and the DrPH program to conduct training that supported the Caribbean HIV response.

• A grant of 9 million Jamaican dollars from the Epidemiology and Research Training Unit, Kingston, Jamaica (2021/2022) to cover the salary of the DrPH Program Director.

• In-kind contributions and support from international agencies and some Caribbean governments to establish the program and provide financial assistance to students.

• Funds to purchase equipment, computers, furniture, repairs to the Ageing Centre, and assistance to purchase a bus for medical students and improve internet connectivity.

The DrPH faculty also contributes to UWI through grant applications, technical reports, collaborations (cross-campus, regional, and international), board memberships, guideline development groups, and research.

Challenges

Many public health professionals who would benefit from the program have not applied because the DrPH is not required for appointment as a public health specialist in the government health service in Caribbean countries. Many students find tuition and other costs challenging. When the program first started, students from Barbados and Trinidad and Tobago received 50% of tuition cost from their respective government, but this support is no longer available. Some DrPH students have benefited from the Dr Barry Wint Memorial Scholarship established by the Ministry of Health and Wellness, Jamaica in 2025.

Some students are taking longer than the usual limit of 7 years to complete the program because of challenges such as work pressure of full-time jobs, inability to get study leave or flexitime at work, and personal or family issues. The few DrPH faculty are over extended and few suitable research supervisors are available to support students. Some students have excellent field placement experiences while others work in more difficult circumstances. Students wishing to do electives at leading public health schools abroad must submit a written request to a UWI committee that meets twice yearly. Certificates of satisfactory completion of such courses are not accepted by UWI and transcripts require additional tuition costs.

Sustainability

Ensuring sustainability of the DrPH program is a challenge. An external review of the DrPH program in 2017 recommended a minimum of three full-time faculty members to manage the program. Initially there were two full-time faculty members assigned to the DrPH. Currently, there is one full-time faculty member (Dr Jacqueline Duncan) supported by an administrative assistant. Dr Figueroa, Professor Emeritus, offers support to the program through teaching, course coordination, examinations, research supervision, advocacy and acts in an advisory capacity. Other adjunct faculty and personnel within and outside UWI also support the program, often without remuneration. Past attempts to recruit suitable faculty members at Mona were unsuccessful as public health doctors are paid considerably more in government service than at UWI.

Restructuring the doctorate in public health

A proposal for restructuring the DrPH program was endorsed by the DrPH Specialty Board in 2024. The Board of Graduate Studies approved the proposal and assigned nine credits for the comprehensive year 2 examination and 18 credits for the thesis increasing the credit requirement for the DrPH degree from 42 to 69 credits. A Master of Applied Public Health (MAPH) was approved as an exit strategy for students who successfully complete the DrPH Part 1 (core courses and examinations at the end of year2) plus 6 months of field placement but are unable to complete the research thesis. Seven students from cohorts 1 to 6 are recommended for the MAPH. The DrPH degree is awarded after successful completion of the DrPH Part 1 (core courses and examination at the end of year 2) and Part 2 (field placements, electives, and research thesis). Preparation of two research publications is now an alternative option to the traditional written thesis. Either option requires an oral defence.

DISCUSSION

The DrPH at UWI is the only professional public health doctorate program in the English-speaking Caribbean. The program has established itself as a high-quality program that produces leaders in public health across the Caribbean. The depth and breadth of the curriculum and rigor of research theses have been documented by the students, the Faculty of Medical Sciences, the Office of Graduate Studies and Research, and a 2017 external review of the DrPH, and it has been lauded by the four external examiners since the program’s inception. Most graduates have remained in the Caribbean and contribute to improving the capacity of public health systems and training institutions throughout the Caribbean. This is an important achievement given the high rate of migration of Caribbean health professionals (7,10,11).

The competencies covered by the DrPH are similar to those identified by the United States Council on Linkages between Academia and Public Health Foundation (23), the WHO-ASPHER Competency Framework (24), the Canadian core competencies for public health (25), and those identified by the United Kingdom’s Faculty of Public Health (26). The goals of the DrPH are consistent with the vision of earlier reports (27,28). The MPH is recognized as a foundation for public health practice but the DrPH bridges the gap between public health practice and research with an aim to produce transformational leaders in public health. These gaps became more obvious during public health crises such as the COVID-19 pandemic resulting in calls to reinvest in leadership training and produce a “new generation of public health leaders” (29).

While attempts have been made to develop theoretical frameworks to synthesize what is known about building competencies in health professionals and guiding training programs (30,31), we believe that our approach is consistent with best practice in the field and well suited to the needs, context and challenges faced in the Caribbean. Our approach has been to develop core public health competencies using evidence and through practical exercises, assignments, and field placements while emphasizing critical values, attitudes, and ethical practice. Thus, the DrPH program is not simply a credentialling or academic exercise. Growth in professional expertise in public health is expected and assessed.

The DrPH recognizes that the public health field is dynamic with emerging challenges that need to be addressed (32). Developing meaningful partnerships across sectors to empower communities, and promote and protect health necessitates building effective multidisciplinary teams. Hence the justification for not restricting the DrPH programs to medical doctors and for requiring an MPH or equivalent degree for entry into the program. The current DrPH model has disrupted traditional hierarchical models and promoted genuine recognition of different disciplines and roles while fostering a coherent public health identity and team. The digital revolution has the potential to increase the availability and uptake of public health training at reasonable cost (33). A United States survey found that within educational institutions there was insufficient understanding of the difference between the DrPH and PhD degrees (34), a problem that we also encounter.

Caribbean health ministers have agreed in principle that the DrPH, or its equivalent, would become the required standard for specialist public health practice at the consultant level in the Caribbean. However, this principle is still to be implemented. In 2017, Caribbean health ministers urged Member States with capacity to absorb DrPH graduates and to employ them with a view of formally recognizing their specialist training. The medical councils of Barbados and Trinidad and Tobago have a register of medical specialists and recognize the DrPH and Doctor of Medicine programs at UWI as the direct route for specialist registration. The Medical Council of Jamaica is considering similar requirements for specialist registration.

Caribbean governments need to recognize the DrPH as the terminal (final) degree for public health specialists and a requirement for high-level public health leadership positions in the Caribbean. Their support of the program is a critical investment in building capacity in public health leadership across the region. More flexible administrative measures are needed to allow scholars to attend teaching blocks, participate in field placements, and complete their research theses without loss of salary or vacation leave. The recent DrPH restructuring and inclusion of the MAPH will facilitate the flow of students who find it difficult to complete their research thesis. The introduction of manuscript-based theses should increase access to research findings and improve competency in drafting research papers.

Conclusions

The establishment of the DrPH program at UWI is an important achievement that contributes to strengthening public health capacity in the Caribbean as shown by the high retention of graduates in the Caribbean, placement in senior positions, institutional strengthening, and actual policy and system outputs. Recent restructuring of the program should facilitate students completing the program in a timelier manner. Research supervision, mentoring, and coaching during field placements needs improvement. However, Caribbean health services should facilitate students more readily through study leave, flexitime, and funding support. While heads of governments of Caribbean countries have declared that “the health of the Caribbean is the wealth of the Caribbean” (35), they need to support expansion of the DrPH faculty and insist that people being appointed to senior technical public health leadership positions must complete the DrPH or an equivalent degree.

Data availability:

No new data generated.

Declaration of artificial intelligence (AI) use:

No AI tool was used.

Disclaimer:

The authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the Revista Panamericana de Salud Pública / Pan American Journal of Public Health and/or those of the Pan American Health Organization and the World Health Organization.